Social, Psychological, and Behavioral Predictors of Salivary Bacteria, Yeast in Caries-Free Children.

INTRODUCTION: Early childhood caries (ECC) is a complex, multifactorial oral disease that is a major public health concern because it is prevalent, profoundly alters a child's quality of life, is difficult to treat effectively, and has a distressing tendency to recur following treatment. OBJECTIVES: The purpose of the study was to examine social, psychological, and behavioral predictors of salivary bacteria and yeast in young children at risk for ECC. METHODS: A sample of 189 initially caries-free preschool children was assessed for child stress physiology from salivary cortisol, child and family stress exposure, diet, oral health behaviors, and sociodemographic risks. Multiple logistic regression analysis was implemented to examine the associations between these risk factors and cariogenic microorganisms: mutans streptococci (MS), lactobacilli (LB), and Candida species. RESULTS: Higher baseline salivary cortisol (odds ratio [OR] = 6.26; 95% confidence level [CL], 1.69-23.16) and a blunted response to an acute laboratory stressor (OR = .56; 95% CL, .37-.83) were associated with an increased likelihood of elevated salivary MS (≥105 colony-forming units/mL) in caries-free children. Sociodemographic risk for cariogenic microorganisms was also found. Specifically, lower education attainment of the parent/primary caregiver was associated with children being more likely to carry salivary Candida species and elevated salivary MS; in addition, children from households with an unemployed parent/primary caregiver were more likely (OR = 3.13; 95% CL, 1.2-8.05) to carry salivary Candida species and more likely (OR = 3.03; 95% CL, 1.25-7.33) to carry elevated levels of MS and/or salivary Candida and/or LB. CONCLUSIONS: The impact of sociodemographic risk and stress physiology on cariogenic disease processes are evident prior to ECC onset. The findings provide novel data on the early onset of cariogenic processes in children and the importance of considering sociodemographic, psychosocial, and behavioral factors when judging ECC risk. KNOWLEDGE TRANSFER STATEMENT: The findings provide valuable and novel findings that, pre-ECC onset, the caries disease process is explicable from a detailed assessment of behavioral, sociodemographic, and psychosocial stress variables.

Early prognosis in patients with community-acquired severe sepsis and septic shock: analysis of 184 consecutive cases.

PURPOSE: To determine the risk factors on hospital mortality in patients with community-acquired severe sepsis and septic shock in the first 24 hours after admission to the intensive care unit. MATERIALS AND METHODS: The study was prospective, observational, single-centre and included adult patients with community-acquired severe sepsis and septic shock. Demographics, clinical, laboratory and microbiological data were recorded. The main outcome measure was hospital mortality. RESULTS: During the study period, 184 patients were included. The overall mortality rate was 51.6%, 44.4% with severe sepsis and 71.4% in patients with septic shock. The lung was the most common site of infection (65.8%) and respiratory failure was the most common organ failure (54.9%). Multivariate analysis identified four independent risk factors for mortality in patients with severe sepsis and septic shock: three or more organ dysfunctions (OR, 3.212; 95% CI, 1.585-6.506; p<0.001), acute respiratory failure (OR, 2.649 95% CI, 1.327-5.287; p=0.006), positive blood culture (OR, 2.708; 95% CI, 1.289-5.689; p=0.009) and chronic heart failure (OR, 2.112; 95% CI, 1.036-4.308; p=0.040). CONCLUSION: Our results highlight the importance of three or more organ dys-functions, acute respiratory failure, positive blood culture and chronic heart failure as independent risk factors for mortality in the first 24 hours after admission in patients with severe sepsis and septic shock. This will benefit the early identification of patients at high risk for poor outcomes that contributes to intensive management and appropriate treatment interventions.

Femoropopliteal bypass vs percutaneous transluminal angioplasty and stenting in treatment of peripheral artery diseases of infrainquinal segment - short-term results.

(Full text is available at http://www.manu.edu.mk/prilozi). Critical limb ischaemia is a result of occlusive arterial disease in the infrainquinal segment and is a major indication for arterial revascularization, which implies a femoropopliteal bypass procedure or an interventional procedure - stent graf notting of the occluded segment. Although indications for both techniques are clearly defined, there are still controversies. Thus, the aim of this study was to determine short-term results in patients treated with these two treatment modalities. In the period between 2002 and 2008 a total of 70 patients with occlusive arte notrial diseases of the low extremity were analysed. In 50 out of 70 patients a femo notro notpopliteal bypass was made. Of these, in 30 (60%) patients PTFE material was used and in 20 (40%) patients an autologous saphenous vein graft was used. The other group comprised 20 patients who underwent stenting. In patients treated with surgical revas notcularization, the major indication for surgery was occlusive arterial disease in: stage II - in 10 patients (20%), stage III - in 5 patients (10%), stage IV - in 25 patients (50%) and the remaining 10 patients (20%) had subacute ischaemia. Arteriography showed three crural patent tributaries in 18% of the patients, two patent crural tributaries in 40% of the patients and one crural patent tributary in 32% of the patients. There were no significant differences concerning indications and arteriographic findings between the two subgroups. The follow-up period lasted for 6 months and the patency rate was 85% (17) for venous bypass, 11 (64.6%) - short-segment lesions (< 4 cm) and 6 (35.3%) lon notger segment lesions (> 4 cm) versus 76.5% (23) for PTFE graft (p < 0.05), of which 13 (56.5%) were short-segment (<4 cm) and 10 (43.5%) longer segment lesions (> 4 cm). The following results were obtained for the second group of patients: initially successful stents in 85%; failure in 15% or 2 patients; technical failure in 1 patient or 5%. After 6 months the patency rate was 75% (15), of which 11 patients (73.2%) had short-segment occlusions (< 4 cm) whereas 4 patients (26,8%) had lesions > 4 cm. The baseline value of the lower limb index (ABI - ankle-brachial index) was significantly increased in both groups, from 0.41 to 0.91 in the group with surgical revascularization and from 0.47 to 0.88 in the second group treated with stenting. The same trend was observed after six months. This study demonstrated a small but significant difference (85% vs 75%, p < 0.05) in favour of the autologous saphenous vein, which should be a preferred graft material in all cases for reconstruction of the femoropopliteal segment. When compared to the overall patency rate of PTFE grafts after 6 months there was no significant difference in patency in the group treated with stent grafting (76.5% vs 75%). However, stenting is a method of choice in the treatment of short-segment occlusions - smaller than 4 cm with good early run off (73.2% vs 64.6%, p > 0.05 p = ns). It is obvious that the results are identical to those in treatment with an autologous great saphenous vein, but in comparison with PTFE the results imply stent usage (73.2% vs 56.5%, p < 0.005). Prosthesis (PTFE) is a graft material of choice when the great saphenous vein is used, damaged or calcified and when the occlusion is longer than 4 cm and is not suitable for stent grafting (43.5% vs 26.6%, p < 0.001). Key words: peripheral artery disease, femoropopliteal bypass, percutaneous translu notminal stent angioplasty.